目的：观察地佐辛(DEZ)静脉自控镇痛(patient-controlled analgesia,PCA)对肺叶切除术术后患者炎症反应的影响并评价其镇痛效果。方法选取60例拟行开胸肺叶切除术的患者,随机分为对照组和 DEZ 组,各30例。对照组术后PCA泵注0.9%氯化钠,DEZ组PCA泵注0.5 mg/mL地佐辛。采集患者麻醉诱导前(T0)、术后4 h(T1)、术后24 h(T2)和术后48 h(T3)血标本,测定C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)、IL-2、IL-6和 IL-10的水平。于T1、T2和T3时点随访患者,记录患者生命体征、视觉模拟评分(VAS)、数字镇静评分(NSS)、不良反应发生情况及患者满意度。结果两组患者术后CRP、TNF-α、IL-6和IL-10的水平较术前明显升高,IL-2的水平较术前降低(均P<0.05)；DEZ组术后CRP和IL-6水平明显低于对照组,而IL-2水平高于对照组(均P<0.05)。此外,DEZ组患者术后各时点的 VAS评分低于对照组,患者满意度评分也较高(均P<0.05)。结论地佐辛静脉自控镇痛能在一定程度上减轻开胸肺叶切除术术后炎症反应,并提供安全有效的镇痛质量。%Objective To investigate the effect of patient-controlled analgesia(PCA)with dezocine on the inflammation after pulmonary lobectomy and evaluate its postoperative analgesic effect.Methods A total of 60 patients scheduled for pulmonary lobectomy were enrolled in this study.They were assigned to control group(PCA with 0.9% sodium chloride,n=30)and DEZ group(PCA with 0.5 mg/mL dezocine,n=30)at random.The levels of serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-2(IL-2),interleukin-6(IL-6)and interleukin-10(IL-10)were determined in blood samples harvested be-fore induction of anesthesia(T0),4 h after operation(T1),24 h after operation(T2)and 48 h after operation(T3).Patients’vital signs,visual analogue scale(VAS)scores,numeric sedation scale(NSS)scores,adverse effects and patients’satisfaction were re-corded at T1,T2 and T3.Results The levels of serum CRP,TNF-α,IL-6 and IL-10 were increased remarkably after the opera-tion,while the level of IL-2 was decreased in both groups.The postoperative serum CRP and IL-6 levels in DEZ group were lower than those in control group(P<0.05).The postoperative serum IL-2 level in DEZ group was higher than that in control group(P<0.05).VAS scores were reduced at 4,24 and 48 h after operation and the satisfaction of patients to analgesia was higher in DEZ group(P<0.05).Conclusion PCA with dezocine can alleviate the inflammation to some extent in patients after pulmonary lobectomy,and it can offer a safe and effective analgesic effect.
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